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Antioch Baptist College
E-mail us at antiochbaptistcollege@hotmail.com

APPLICATION FOR ENROLLMENT
There is a 40.00 fee for enrollment
We will contact you after the enrollment form is accepted.
  

Last Name:
 First Name:
 Middle or Maiden Name:
Mailing Address:
City:
State:
Zip:
Phone Home:
Phone Work:
E-Mail Address:
Place of Birth City:
State:
Marital Status:
Single Divorced
Married Other
Name of Spouse:

Date of Birth:

Sex:
Male Female

CITIZENSHIP

Place of Birth:

Are you a citizen of the United States:

 Yes    No

IF NO, ANSWER QUESTIONS BELOW
Of what country are you a citizen:
Are you a permanent resident of the United States?: Yes    No
Alien Registration Number:
Do you presently have a United States Visa: Yes    No
If yes what type:
Expiration Date:

EDUCATION INFORMATION

Name of Institution:
City:
State
Dates attended:
From
   		 To
Degree(s) received
Credits Earned

Semester.

 Quarter
Name of Institution:
City:
State
Dates attended:
From
   		 To
Degree(s) received
Credits Earned

Semester.

 Quarter
Name of Institution:
City:
State
Dates attended:
From
   		 To
Degree(s) received
Credits Earned

Semester.

 Quarter

BACKGROUND INFORMATION

Present Occupation:
How Long:
Employer:
Address:
Name of Your Local Church:
Pastor's Name /Address:
Are you a Minister: Yes No Licensed: Yes No Ordained: Yes No
Other:

How Long have you been in Full-Time Christian Service:
Yrs
 Months
What Denomination Do you Classify Yourself As Being:
Friend or Next of Kin:
Address:

 

  

For additional information call (513) 314-9396 or (513) 367-6713


ANTIOCH BAPTIST COLLEGE
One North Commerce Park Drive - Suite 109
Cincinnati, OH 45215 - (513) 314-9396
Fax: (513) 845-6713
© 2008 Antioch Baptist College.